10 January 2017
: Case report
Aspergillus Terreus Brain Abscess Complicated by Tension Pneumocephalus in a Patient with Angiosarcoma
Unusual or unexpected effect of treatment, Rare coexistence of disease or pathology
Thejal Srikumar1ABEF, Smitha Pabbathi2ABCDEFG, Jorge Fernandez1AD, Sowmya Nanjappa2ABCDEFG*DOI: 10.12659/AJCR.900425
Am J Case Rep 2017; 18:33-37
Abstract
BACKGROUND: Aspergillus terreus is an evolving opportunistic pathogen, and patients with A. terreus often have poor outcomes due to its intrinsic resistance to several systemic antifungal agents. Here we present a unique case of intracranial abscesses of A. terreus in a patient with recurrent angiosarcoma, complicated by development of tension pneumocephalus.
CASE REPORT: A 67-year old gentleman with history of scalp angiosarcoma with wide excision two years prior presented to the hospital for left arm clumsiness, altered mental status, and low-grade fever. Staphylococcus aureus and Proteus mirabilis bacteremia was detected, and Computed Tomography (CT) of the head showed right frontal lobe abscesses. He was started on steroids, intravenous vancomycin and cefepime, and was eventually discharged. He presented to the hospital again due to persistent and worsening symptoms. MRI showed progression of the brain lesions, and surgical biopsy and culture of lesions revealed A. terreus and gram-positive cocci. He was started on trimethroprim/sulfamethoxazole and voriconazole and symptoms improved. On post-op day four, he acutely decompensated with total loss of left arm strength; MRI demonstrated tension pneumocephalus. Conservative management was undertaken with continuous supplemental oxygen. Serial x-ray imaging over the next week demonstrated resolution of the pneumocephalus, and the patient was able to regain all proximal lower and upper extremity strength.
CONCLUSIONS: Never before has a case of A. terreus been associated with angiosarcoma or tension pneumocephalus in the literature. Proper identification and prompt diagnosis of species is crucial in the immunocompromised patient. Tension pneumocephalus should be included in the differential diagnosis of nontraumatic hemiparesis for emergent evaluation and management.
Keywords: Aspergillosis, Aspergillus, Hemangiosarcoma, Neuroaspergillosis, Pneumocephalus
SARS-CoV-2/COVID-19
04 July 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.934468
29 June 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936896
16 June 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936498
13 June 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936889
In Press
05 Jul 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936585
05 Jul 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.935885
05 Jul 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.934951
05 Jul 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936165
Most Viewed Current Articles
23 Feb 2022 : Case report
DOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250
17 Feb 2022 : Case report
DOI :10.12659/AJCR.934399
Am J Case Rep 2022; 23:e934399
06 Dec 2021 : Case report
DOI :10.12659/AJCR.934406
Am J Case Rep 2021; 22:e934406
09 Feb 2022 : Case report
DOI :10.12659/AJCR.934744
Am J Case Rep 2022; 23:e934744